Agenda item

To follow

Attending for this Item were:

Herefordshire and Worcestershire Clinical Commissioning Group (HWCCG)

Carol Rowley, Dementia Services Lead

Herefordshire and Worcestershire Heath and Care NHS Trust (the Trust)

Dr Dhan Marrie, Consultant in Older Adult Mental Health

Worcestershire County Council (the Council)

Matt Fung, Public Health Consultant

By way of introduction, a summary of the Agenda Report was provided.  Members learned that prevention was an important work area and a number of lifestyle interventions, such as limiting alcohol use, reducing obesity and controlling blood pressure, may prevent or delay dementia onset.

During the COVID-19 pandemic, funding had been received to enhance the memory assessment service. Clinical Staff had been redeployed and there was a backlog of cases, however the additional funding had been used to manage the service which was now operating at pre-pandemic levels.

Nationally, there was a recommendation to diagnose dementia within 12 weeks and statistically, Worcestershire was measured as having a diagnosis rate of 67%.  This was explained as a prediction that around 8,000 residents were aged 65 or over and two thirds would expect to have dementia.  There were currently around 4,600 diagnosed residents, meaning that an additional 1,350 patients would need to be found.  Worcestershire was currently performing at around 50%.  A recent NHS England study suggested that diagnosis rates were higher in urban areas.

Work on the County Dementia Strategy had paused during the COVID-19 pandemic; however, activity was restarting and professionals from various sectors were actively engaged.  Activity and awareness raising was encouraged and a mapping exercise had taken place to establish what services were available across the County to identify any gaps in provision.

Care Home diagnosis rates would be expected to be around 80%, however, some Worcestershire Care Homes had figures as low as 40%.  This was currently a piece of focussed work.

Members were invited to ask questions and the following points were made:

·       When asked to what extent GPs were trained, it was reported that across Herefordshire and Worcestershire the level of understanding was high, with very experienced GP Leads.  Lunchtime education sessions for GPs were being developed and some GPs were able to diagnose

·       Low Care Home diagnosis rates was of concern; however it was suggested that the focus was on early detection and residents in Care Homes may have more advanced dementia

·       The Council and HWCCG were working together to better understand the national modelling to determine whether the 67% estimate was a true reflection of the situation in Worcestershire.  Members learned that only age and sex were used in the modelling and no account was taken on other factors such as social isolation, levels of deprivation or any hearing loss.  There was a known link between hearing loss and dementia.  People with hearing loss generally became withdrawn resulting in the brain becoming less stimulated

·       NHS England reported that urban areas usually achieved, or exceeded, the target of 67% diagnosis.  When asked whether the working life of a resident could be of relevance, it was reported that it could and the risk factors could be more prevalent

·       Although the target for Worcestershire was 67%, it was known that Staffordshire had a higher diagnosis rate

·       Prevention was key and promoting healthy lifestyles could benefit residents.  The increase in update of NHS Health checks was one area which was of particular focus

·       Members sought clarity on the Dementia Pathways learning that there were 2 ways of diagnosis.  For early intervention, proactive pre-assessment with support and opportunities in the community was available.  For residents who had loss of function, the Community Mental Health Team would become involved and adaptations would benefit.  An example could be the use of assistive technology to manage medication 

·       In response to a query as to how COVID-19 had affected the onset of dementia, it was reported that all work areas had been affected by the pandemic, however, the number of referrals dropped during the early stages of the pandemic 

·       A pilot project was in place with Advanced Nurse Practitioners looking at the low rates of dementia within Care Homes.  It was reported that clinicians did not believe it was right to screen all Care Home residents and diagnosis was often given at the same time as another referral

·       In response to a question as to the effectiveness of treatment in slowing down dementia, it was reported that oral medication was not that effective.  Research had shown that living independently for as long as possible before moving to residential care helped.  Other examples included treating other ailments as quickly as possible and the introduction of talking therapies.  There was also no strong link between Hormone Replacement Therapy and dementia prevention

·       A Member commented on the wide ranging diagnosis rates across each of the District Council areas

·       When asked how dementia diagnosis was performing against the 12 week target, it was reported that it was performing well and back to pre pandemic levels, however, it was unlikely to reach 100% as patient choice had to be factored in.  For clarity, it was reported that assessments were now undertaken in a timely manner, however GPs would often have to rule out other ailments before a referral.  It was agreed to provide the HOSC with recent further information on performance

·       When asked about trends in early onset dementia, it was reported that around 400 Worcestershire residents were diagnosed, the youngest being 29.  Memory services were more involved at this stage as the needs of this group of patients was different as they may have families, employment and other responsibilities for example

·       The Addenbrooke’s Cognitive Examination was a tool used to determine the level of memory loss and resources were available.  Workstreams included the Dementia Well Pathway.

The Managing Director of Healthwatch Worcestershire was invited to comment on the discussion and referred to the support available to the 400 residents with early onset dementia and whether it equitable across the County.  It was clarified that the 400 figure would form part of the 67% target rate and rates were in line with national figures as of 2019.

The Chairman thanked everyone for a useful discussion and asked for an update at an appropriate time in the future.